If you have ever endured the burning sensation in your chest accompanied by the sudden appearance of fluid (that vaguely bears the taste of the food you had eaten) in your food pipe that makes you feel like throwing up, then you are not alone! You are part of a large community of co-sufferers, enduring the same suffering. Acid reflux is the common thread (read: ailment) that connects us all and sets our chests’ on fire. Some experience it as a once-in-a-while thing, while others bear with it regularly. But no matter the frequency of the suffering, it is an unpleasant experience that we all would want to avoid. So, let’s dive into the fiery pit of acid reflux and understand its causes, symptoms, and cures.
What is Acid Reflux?
Our stomach is more than a simple muscular pouch, as it houses the digestive enzymes and acids, and initiates the process of protein and lipid digestion.
Hydrochloric acid is the primary stomach acid secreted by the cells (parietal cells) of the stomach. It is highly acidic and is responsible for maintaining the acidic pH of the stomach to facilitate digestion. Now, the stomach’s inner lining is resistant to the burning effects of hydrochloric acid (thanks to the mucus lining it). But, the trouble begins when this acid moves out of the stomach into the esophagus.
Acid reflux is the condition in which the stomach acid (hydrochloric acid) moves out of the stomach and up into the esophagus, causing the familiar burning sensation and regurgitation. The throat and abdomen are separated by a muscular valve known as the esophageal sphincter, which allows a one-way entry of food from the esophagus into the stomach. It usually prevents the back-flow of stomach contents into the esophagus. But due to a variety of reasons (which we will be discussing in a wee bit), the esophageal sphincter might not function effectively, resulting in acid reflux.
Acid reflux is common, and most people suffer from it at least once or twice (at the minimum) during their life span. But, when it becomes a regular phenomenon, meaning more than twice a week, it attains the status of a disease and is termed gastroesophageal reflux disease (GERD). The severity of GERD depends on the extent of esophageal sphincter dysfunction, the amount of fluid brought up from the stomach and the saliva’s neutralizing efficiency.
According to a research survey conducted by the American College of Gastroenterology, around 60 million Americans suffer from acid reflux pangs once a month, and 15 million experience it daily. A recent study also showed that GERD affects about 18.1-27.8% of the North American population and 23% of the South American people. While it is common to experience acid reflux once in a while, the frequency and severity have increased over the decades and is linked to the obesity problem that has been on the rise in America. Obesity is a risk factor for acid reflux and is one of the primary causes of GERD. The high-fat diets of a majority of the American population and the sedentary lifestyles add fuel to the already burning fire of acid reflux.
There is a common misconception that acid reflux results from the presence of excess acid in the stomach. But this could not be farther from the truth. Acid reflux is caused due to the movement of the stomach acid into the esophagus and has no relation to the amount of acid present. It’s about time we set the record straight regarding the actual reasons behind this upward flow of stomach acid.
Hiatal hernia is one of the primary risk factors or causes of acid reflux. A hiatal hernia occurs when a small part of the stomach moves up into the chest through an opening in the diaphragm (muscle separating the chest and abdomen). It may cause the weakening of the esophageal sphincter and lead to its dysfunction. A hiatal hernia may be an outcome of sudden physical exertion or obesity, but it is most commonly due to age and is common in people above 50 years of age.
Obesity is the other leading cause. The extra weight associated with obesity exerts a higher pressure on the stomach and other internal organs, leading to hiatal hernia and stomach acid’s back-flow. Sometimes, the extra load on the stomach also forces the acid upwards, even without a hernia. Also, the hormonal changes related to obesity play a role in triggering acid reflux. Thus, the rise in obesity in the US goes hand-in-hand with the increase in acid reflux cases.
GERD or acid reflux is a gut-related disorder, and so diet plays a crucial role in its manifestation. An article published in the Gastroenterology Research and Practice Journal had found the correlation between the intake of fatty foods and GERD. A diet rich in cholesterol and fatty acids is known to cause acid reflux. A high-fat meal triggers the release of more nitric oxide (a neurotransmitter) that signals the enteric nervous system to keep the esophageal sphincter open, leading to the back-flow of stomach acid into the esophagus. Also, a diet loaded with unhealthy fats and oils leads to obesity, leading to acid reflux. So, it is like a vicious cycle that can only be broken by changing our diet.
Smoking is another reason, as the nicotine from tobacco relaxes the sphincter and allows the reflux of the gastric juices into the esophagus.
Pregnancy, too, is another significant risk factor for acid reflux. The hormonal changes during pregnancy lead to a surge in progesterone levels, which is responsible for relaxing smooth muscles throughout the body. Progesterone’s action also has an impact on the esophageal sphincter, causing it to relax and enable the reflux of stomach constituents. Also, as the fetus grows, it exerts more pressure on the stomach and causes the stomach juices to spill over to the esophagus.
With the causes known, it is essential to note down how acid reflux or GERD manifests, i.e., the symptoms so that we can spot them the next time around and not mistake them for something else.
Heartburn is the major symptom associated with acid reflux. Although the name suggests that it has something to do with the heart, but in truth, it does not. It is a burning sensation in the chest region behind the sternum (aka breastbone) and is accompanied by a spasm or sharp pain. This burning sensation is often mistaken for a heart attack, and that must be the reason behind the given name.
Regurgitation is the other primary symptom that goes hand in hand with heartburn. It involves the spilling over of undigested food mixed with gastric juices into the esophagus from the stomach due to the relaxed sphincter.
Experiencing bloating is another common symptom associated with acid reflux. Bloating is usually related to the presence of excess gas in the stomach. GERD, along with other gut-related disorders, is known to cause a build-up of gas and lead to the feeling of bloatedness.
The sour taste in the mouth experienced due to acid reflux and regurgitation of the undigested food, along with the burping and belching, makes one feel nauseated and may even lead to vomiting.
Difficulty in breathing is one of the alarming symptoms associated with GERD. Shortness of breath is the most common one among them. The stomach acids that enter the esophagus may creep into the lungs and cause swelling of the airways (mainly while sleeping). Such abnormalities often lead to chronic coughs and wheezing.
Over-the-counter medications are the most common treatments available to relieve oneself of the symptoms associated with acid reflux or GERD. These medications are generally classified into:-
- Proton pump inhibitors (PPIs)
- Histamine H2-receptor antagonists (H2 blockers)
These are different categories of drugs with specific modes of action that help relieve symptoms associated with a particular disease.
The proton pump inhibitors such as omeprazole, esomeprazole, etc. work by reducing the amount of stomach acid produced by blocking the enzyme in the wall of the stomach that produces the acid. This results in less acid production, and so, when there is acid reflux, the patient does not experience any burning sensation or pain due to the reduced amount of acid.
H2 blockers work similarly. They act on the cells that produce stomach acid and stop the excessive production of acid. They are known to reduce acid production by 70% within 24 hours. Ranitidine and Cimetidine are the common H2 blockers available in the market.
Antacids are another class of medications that are commonly used to treat the symptoms of acid reflux. They work a little differently than PPIs and H2 blockers as they do not target the amount of acid produced, but work on neutralizing the acid produced. They contain ingredients such as aluminum, sodium carbonate, magnesium, etc., which are alkaline or basic and work to neutralize the stomach’s acidic pH.
Alginate drugs mainly contain an antacid along with alginic acid. The antacid neutralizes the gastric juices. The alginic acid forms a foamy gel layer on top of the gastric contents and acts as a mechanical barrier to prevent the backflow of the stomach juices. Any reflux that may occur is relatively harmless as it contains alginic acid and the neutralized stomach juices.
Other than these medications, surgery may be undertaken in cases of severe GERD, wherein the patient is unresponsive to other treatments, and there is acute valve dysfunction.
Side Effects of the Medications
Although these medications are efficient in relieving the symptoms of acid reflux within a short period, they do no treat the root cause of the ailment and, along the way, also cause collateral damage to the body. They tend to change the stomach acidity, which impacts overall digestive health. These medications usually do not have any side effects on immediate use, but over time and with prolonged use, they do have some pronounced ill effects on the body.
Proton pump inhibitors are known to affect the composition of the gut microbiome, leading to a decrease in the number of beneficial gut bacteria and an increase in the harmful ones. The other common side effects include headaches, diarrhea, constipation, and abdominal pain. Long-term use of PPIs may lead to more severe side effects such as kidney diseases, vitamin deficiencies, and an increased risk of a heart attack.
H2 blockers and alginates, like PPIs, cause headaches, diarrhea, and constipation in some users as side effects. Also, it is essential to know that in April 2020, the Food and Drug Association (FDA) had requested that all forms of Ranitidine (a type of H2 blocker) be removed from the US market because unacceptable levels of NDMA (N-Nitrosodimethylamine), a probable carcinogen, were found in some ranitidine products.
Although the side effects of antacids are rare, they sometimes can cause constipation or have a laxative effect. In other cases, they may also lead to sensitivity to certain foods and trigger allergic reactions.
Apart from taking a toll on our overall health, these medications are also taxing on our wallets. According to a survey conducted in 2009, the total expenditure on gastrointestinal diseases in the US was estimated to be $142 billion in direct and indirect costs. Out of this, GERD accounts for $15-20 billion of these costs. It has also been estimated that medications for acid reflux or GERD, mainly proton pump inhibitors, account for around $10 billion in annual healthcare costs. If these numbers are anything to go by, the cost of these over-the-counter treatments surely does burn up a hole in our pockets.
Fret not! Ayurveda is the perfect antidote to all these medications that weigh heavily on our bodies and pockets. It is the holistic way of curing any disease, as it treats the root cause and not just the symptoms. Conditions such as GERD, are easily curable by making some well-informed changes in one’s diet and lifestyle, and Ayurveda shows us how. We don’t have to shell out a lot of money, as the Ayurvedic way is easy on our bodies and our wallets. The simple changes in diet and lifestyle hardly cost anything compared to the big dollars that we spend on medications and other allopathic treatments, and the fact that it comes with a no side-effects clause is the cherry on the icing! All you need to do this head on to the next article to discover the simple and effective Ayurvedic secrets of curing acid reflux.
See you on the other side!